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y Island I Forytiard <br /> ln <br /> El Keller Canyon ❑Coffin Butte Dox oun�andflli Sanitary Landlilt Landfill <br /> Sanitary Landfill Landfill Sanitary 1601 Dixon Landing Road 9998 5.Auetln Hoed <br /> 901 Salley Road 28972 Ia. O Butte Road 12310 San MateoCA 84010 Minae, CA 95095 Manteca,CA 95336 <br /> pinaburg, CA 94505 Corvallis, OR 97380 NaN MdOn Bay, Phona (408) <br /> P'none{925)458.9800 Phone (541)746 20`18 PhFax one (6501 728-18 1 9 F (408)2S2-2878 Fax( (2091982-982-420 <br /> 88 <br /> 11000 <br /> Fax(0281458-9891 Fax (54 1}746-3826 Fax 1650)7261 IR3 <br /> NDN•HAZARODUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Corhina'3e1(9rain C 7710 <br /> MAILING ADDRESS <br /> CI TATE <br /> R UIRED NAL RO UI MENT <br /> ZIP <br /> Cj GLOVES ❑GOGGLES 7 RESPIRATOR 7lr]HARD HAT <br /> PHONE 0TY-VEK CIS SAFETY VES` <br /> 0 ACT PERSON SPECIAL HA44OLING PROCEDURES; <br /> 7 enT Idr DATE <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE <br /> 9k' <br /> daNEFlAt'�p'a CERTiFiCArIIX4: hoiabfmnM inaelM U;bvv namaat mo�erleae sola MiarCbvl <br /> rut0udcl aJIl aCepa partdand is!tn IP a22al r Coproma wdaof wlan o nal Can pmabll' <br /> r�aqulrWa^.a,AND,IIHrWgl0l11*traaCant Mid"IlaCpravbua�aClautl Muntdeu"11toa _ <br /> I u laralolho lend elapaak Raaklmlana,leenity Aha u'aalnithaunra rm C°Mttlaatlln RECEIVING FACILITY <br /> R <br /> apa On tha nq.IraM40%al a9 CFR FAX 960 Vila nu kZ,a haxarewa wall*la Jarnad W <br /> aacc«a <br /> W STE TYPE: <br /> DISPOSAL O SLUDGE <br /> QCONSTRUCTION 0WOOD <br /> ❑DEBRIS D OTHER <br /> 0 SPECIAL WASTE — <br /> GENERATING FACILITY <br /> 9304 South Elwlm&ced FltlrllCH CAtuIP <br /> TRANSPORTER NOTES; i VEHICLE LICENSE NUMBER I T)R� K NUMBER <br /> __ ---fir--�-�---• <br /> ADOR <br /> CI ATE,ZIP <br /> END DUMP BOTTOM DUMP TRANSFER <br /> NE <br /> SE{G URE OF AUT ZED AGENT 0 DRI ER CATE ROLL•0 5 FLATBED VAIN DflUOMS <br /> UBIC YARD <br /> 1 hereby certify that the above named material hiss been <br /> accepted and to the beet of my knowtedge the loregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFI_L) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> 0$OIL <br /> EMARKS ❑CONSTRUCTION <br /> DEBRi6 <br /> FACILITY I KE"f NUM R ON N-FRIABLE <br /> SESTOB <br /> SIGN OFAUTH IZED AGENT DATE WOOD <br /> ❑ASH <br /> 0 SPECIAL OTHER <br /> SCH ULI UST 8E MADE PRI TO S;DD RM.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECI <br /> TO RE L UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE r NDIRII.I. T r MAY "GORE <br /> m.Fl <br />